Children Gain Insurance, Adults Lose In 2008

More children had health insurance last year, partially offsetting a growing number of adults who lacked coverage as the troubled economy helped push insurance out of reach for many workers.

Different Counts

The Census Bureau, to determine the uninsured rate, asks people to recall their insurance status for the previous year, and specifically whether they lacked coverage for the entire calendar year. Other government surveys come to different conclusions on the number of uninsured because of the way they ask questions.

For example, some other surveys ask respondents if they are uninsured in the month they are being interviewed, while others try to find out if people have been without coverage anytime in the past two years.

Critics say the Census method might overstate the number of uninsured — as well as undercount those on Medicaid — because people have trouble recalling precisely what their insurance status was the previous year. But proponents say the Census data represent a good, consistent measure and can be used in conjunction with other studies. A report out today in the journal Health Affairs looks at the under/over count issue.

A 2006 report by the Kaiser Commission on Medicaid and the Uninsured explains how three major national surveys look at the uninsured.

New Census Bureau numbers show the total number of uninsured rose to 46.3 million in 2008, up from 45.6 million in 2007. The percentage of uninsured remained at 15.4 percent.

The poverty rate, meanwhile, increased to 13.2 percent — the highest level since 1997. It was 12.5 percent in 2007.

Analysts expect the next Census report, which will be released next year but reflect conditions in 2009, to show an increase in the number of people without insurance, as well as a rise in the number who are living in poverty, reflecting the economy’s continued distress and the rise in unemployment.

If the trends in poverty and uninsurance worsen it will become harder and more expensive to do comprehensive reform, says Dan Mendelson, president of Avalere Health, a consulting firm in Washington.

“They will have to cover more people and it will be more difficult to cover them because tax base goes down,” he said.

Reflecting a declining economy, the number of people covered by job-based insurance fell to 176.3 million in 2008 from 177.4 million the year before. The drop, experts said, occurred for several reasons: rising layoffs and business failures that caused workers to lose their insurance; shifts by some full-time workers to part-time jobs without benefits, and businesses’ reducing or eliminating insurance coverage.

Other findings from the Census included:

7.3 million children, or 9.9 percent, lacked insurance last year. But both numbers were the lowest since 1987, when the data was first collected. Experts credit the drop to efforts to enroll children in Medicaid and the Children’s Health Insurance Program, both of which are joint federal-state health insurance programs for low-income residents.

“This is a testament to the effectiveness of public programs,” said Jocelyn Guyer, co-director of the Center for Children and Families at Georgetown University’s Health Policy Institute.

Excluding children and adults over age 64, who are eligible for Medicare, the percentage of uninsured adults hit 20.3 percent, up from 19.6 percent in 2007.

87.4 million people in 2008 were covered by government health programs, such as Medicaid and Medicare, an increase of 4.4 million from 2007. At the same time, the number of people with private insurance fell by one million last year.

“Both Medicare and Medicaid offset the loss of private coverage, which shows that the safety net is there,” says Peter Cunningham, a senior fellow at the Center for Studying Health System Change, a nonpartisan research group in Washington. “It’s intact for now, but there’s pressure on it.”

Part-time workers were hit hard, with the number of uninsured rising by one million, a 2 percent increase from 2007.

“A lot of employers don’t even offer coverage to part-time workers,” says Cunningham. “But those that do or have in the past are probably reconsidering whether to keep offering it. Even when it is offered, part-time workers are going to be less able to afford it because they’re not earning as much.”

Insurance rates for those born in the U.S. and those born elsewhere remained statistically unchanged from 2007. About 9.5 million of the uninsured are not citizens  and are both documented and undocumented workers — and about 2.8 million are naturalized citizens.

Chart: Coverage By Type Of Health Insurance (Click on plus-sign to enlarge)